The mortality of burn patients is 5%, the majority of which is caused by secondary infections. These infections are not only caused by the fact that burnt skin loses its ability to protect against micro-organisms, but also by the wound liquid produced by a burn wound, exudate, which provides an excellent breeding ground for micro-organisms. Existing wound dressings for burn wounds are complex and their application requires skilled medical personnel. One of the disadvantages of the known wound dressings is that they tend to stick to the wound, which causes wound trauma upon removal, and that they do not allow sufficient evaporation of water content from the exudate, which leads to their relatively fast saturation, which results in a patient discomfort. Moreover, wound dressings must be changed every day because of this fast saturation and in order to prevent infection of the wound.
Currently, there is no wound dressing concept available that sufficiently removes exudates, provides sustained protection against infection, causes no wound trauma upon removal, and can be used without changing for several days. For burn wounds there are several known treatment procedures. One of them includes applying a burn ointment or a burn cream like cerium nitrate-silver sulphadiazine cream directly on the wound, followed by a wound dressing application. Despite the healing potential of the cream, use of the cream together with a wound dressing is not widely applied, since there is no wound dressing available that can sufficiently transport a liquid, that can protect the wound from outside infections and that does not adsorb the cream before application of the cream has resulted in formation a protective layer on the wound. Therefore, in practice, the cream is not used together with a wound dressing unless necessary, like in the case of a face burn injury.
There are a few wound dressings known that possess antimicrobial activity. Those which are meant to be applied on a burn wound are mainly based on the presence of honey and silver. The standards set for honey in such an application are very high and the shelf life of such wound dressings is limited. The amount of released silver-ions—one of the most active substances against infection—is usually high and rises further with increased production of exudate. Moreover, as a drawback, silver promotes the adhesion of the wound dressing to a wound bed.
In order to provide a textile, which is a potential candidate for the production of a wound dressing, with antimicrobial (AM) properties, AM substances might be introduced either into the fibre bulk during the fibre production or onto the fibre surface in finishing processes. In the former case, antimicrobials are only physically incorporated within the polymer bulk and need to migrate onto the surface and be released in order to be effective. The limitation of this modification is thus the short term efficacy. Moreover, the release of antimicrobials to the environment might lead to the development of resistance of micro-organisms to the used antimicrobial compounds and may cause health problems.
Antimicrobials applied by finishing processes are either physically or covalently attached to the surface of textiles. Physically attached compounds are gradually released from the surface and are thus associated with the same problems as antimicrobials incorporated within the fibre bulk, i.e. they leach out of the dressing, which can yield environmental problems, especially in hospital settings, where spilled antimicrobial compounds can give rise to multi-resistant bacteria. Covalently attached antimicrobials show good durability and will not be released, which diminishes environmental problems.
There is no standard solution. The wound dressings that are used in burn centra stick to the dried cream, cannot be applied immediately after the cream application (there is 1-2 hours delay), do not provide any anti-microbial protection and get saturated very quickly. The cream usually needs to be re-applied every 8 to 24 hours.